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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 393608039
Report Date: 04/13/2022
Date Signed: 04/13/2022 12:00:55 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/13/2022 and conducted by Evaluator Christopher Jackson
COMPLAINT CONTROL NUMBER: 53-CC-20220413075101

FACILITY NAME:ST. PETER'S PRESCHOOLFACILITY NUMBER:
393608039
ADMINISTRATOR:HUST, JANFACILITY TYPE:
850
ADDRESS:50 S. LOWER SACRAMENTO RDTELEPHONE:
(209) 368-5929
CITY:LODISTATE: CAZIP CODE:
95242
CAPACITY:72CENSUS: 62DATE:
04/13/2022
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Jan HustTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Allegation: Staff did not report incident in a timely manner
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christopher Jackson met with Preschool Director Jan Hust for the purpose of a complaint investigation. It was alleged on 04/05/22 information was shared regarding an Unusual Incident that occurred. The Unusual Incident Report (UIR) was not reported until 04/08/22. The facility failed to report the Unusual Incident to the department within the 24-hour reporting window. Based on the information obtained, the department has found that the allegation to be SUBSTANTIATED: meaning that the allegation is valid because the preponderance of the evidence standard has been met. Title 22 Deficiencies have been cited on the subsequent 9099-D page of this report and appeal rights provided. This report was reviewed with the director and an exit interview was conducted. Notice of site visit was posted.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Justin L Denton
LICENSING EVALUATOR NAME: Christopher Jackson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 53-CC-20220413075101
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: ST. PETER'S PRESCHOOL
FACILITY NUMBER: 393608039
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/13/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
04/14/2022
Section Cited
CCR
101212(d)(D)
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Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written
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LPA discussed reporting requirement with director. The Unusual Incident Report was provided on 04/08/22.
POC cleared at time of inspection.
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report containing the information specified in (d)(2) below shall be submitted to the department within seven days following the occurrence of such event. This was not met as evidenced by; the facility failed to notify the Department of an unusual incident. This poses a potential health and safety risk to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Justin L Denton
LICENSING EVALUATOR NAME: Christopher Jackson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/13/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2022
LIC9099 (FAS) - (06/04)
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